Generalized Anxiety Disorder

By: 
Dr Jelena Goranovic

Anxious

A person suffering from GAD (also known as the 'free floating' anxiety) may be experiencing a variety of symptoms, including constant worrying, irritability, fear of madness/impending death, sleep problems, inability to concentrate, stomach discomfort, indigestion and diarrhoea, dizziness, headaches, racing heart, chest pain or tightness, etc. Very often GAD runs in families (it is genetically transmitted) and develops gradually over a number of years although negative life events and stress also play a major part in the development and maintenance of symptoms.

As the cause of anxiety seems to be mainly biological, the first choice of treatment in the short-term are usually anti-anxiety medications (the benzodiazepines, such as valium, lorazepam etc.). These drugs increase the function of the brain chemical ('neurotransmitter') called GABA which acts to suppress the activity of brain cells ('neurones'), particularly in the area called the amygdala, the 'panic button' of the brain responsible for triggering the fight-or-flight response. Although these medications can be a life-saver for some, they are only helpful in the short-term as they are addictive and can also decrease alertness and interfere with cognitive performance. For a chronic condition such as GAD, the use of benzodiazepines is therefore contraindicated and another drug class, antidepressants, is the first line of treatment. 

Kava extract was considered to be an effective herbal alternative to benzodiazepines – research has found it to be as effective in reducing anxiety symptoms and it was also helpful with the management of withdrawal from benzodiazepines. However, as with all herbal remedies, reduced side-effect profile does not mean that they are completely harmless. Similarly to alcohol use, a person taking Kava should avoid driving and operating heavy machinery since both drugs (Kava and alcohol) induce drowsiness and sedation.  This herbal extract may also adversely interact with other legal and illegal drugs, it has a high abuse potential and, most alarmingly, chronic use may lead to severe liver damage which is why it has recently been banned from sale in the UK.

There are many alternatives to pharmacotherapy in the treatment of GAD which are certainly more effective in the long term and also without the adverse side-effects.

The non-pharmacological way to reduce the overactivity of the amygdala which underlies GAD and other anxiety disorders are neuropsychological approaches such as the Eye-Movement Desensitisation and Reprocessing (EMDR) and other related techniques (e.g. REM Induction Therapy, Wingwave Coaching). Although a number of clinical studies provided evidence for their effectiveness (particularly with PTSD patients, where EMDR has become the treatment of choice), it is not yet known how such approaches result in the reduction of anxiety symptoms. However, research into the neurobiology of sleep suggests that by simulating the rapid-eye movement (REM) phase of sleep (the phase when we experience dreams) REM-based approaches may facilitate desensitisation of the amygdala by allowing the adaptive processing and integration of negative emotional content.

Apart from the biological underpinnings, there are quite a few cognitive aspects of GAD, such as intolerance of uncertainty, false beliefs about worry, negative problem orientation and cognitive avoidance, which can be challenged and modified by psychological interventions. These include the cognitive behavioural therapy (CBT), neuro-linguistic programming (NLP), hypnotherapy, applied relaxation and other related approaches. A number of research studies have also found mindfulness practice to be very effective in regulating anxiety.

Published by Hove StressBusters
July 2012